One of the quickest outcomes of the III UNGASS-AIDS Forum Indonesia, held in Jakarta on 28–30 May 2009, was the decision to establish a dialogue with the National AIDS Commission. The Forum was coordinated by JOTHI – Network of People Living with HIV. Fifteen civil society representatives discussed and agreed to:

(1) Significantly contribute to building up the country report in partnership with National AIDS Commission;

(2) Collect qualitative data and produce CS report on women’s sexual and reproductive health, advocating for its integration within the national report for UNGASS-AIDS 2010;

(3) Advocate National AIDS Commission for the Indonesian UNGASS Forum to lead the process of NCPI part B.

Rico Gustav addresses the UNGASS-AIDS Forum Indonesia.

A request for a meeting has been submitted to National AIDS Commission, and the secretary of the commission herself has welcome the Indonesian UNGASS Forum. The meeting was held on 14 June 2009. The agenda of the meeting included:

(1) Introduction of the UNGASS Forum and its expanded members;

(2) Inform the NAC on the major points that the 3rd UNGASS-AIDS Forum has agreed on;

(3) Discuss strategies of which the Indonesian UNGASS Forum and National AIDS Commission can collaborate and coordinate in equal partnership, in the sense of monitoring country response to fulfill the Declaration of Commitment;

The NAC representatives, Mrs. Nafsiah and their person in charge on UNGASS Reporting, Mr. Kemal, supported the Indonesian Forum to make the UNGASS-AIDS concepts more down to earth so people in the grassroots level can understand and get familiarized with them. They also agreed to fund UNGASS-AIDS Forum Indonesia to lead the NCPI part B process. And possibly fund an UNGASS-AIDS Regional Forum at the ICAAP.

Furthermore, the Indonesian Forum constituency is developing the research framework based on the instruments and methodology Gestos that is being lead in the country by JOTHI. Besides investigating, the UNGASS-AIDS coalition is mostly responding to growing issues that are currently happening, and coordinating actions among members.

Aditya Wardhana of JOTHI at the III UNGASS-AIDS Forum, in Jakarta.

Just recently, there was information that one of the local government was going to issue a regulation that establishes that couples that are about to marry must be HIV free. This is a very urgent issue to advocate on. One more time, technocrats manage to violate human rights.

Meanwhile, Indonesia organized civil society also face a serious ARV shortage and the spread of disrespectful practices such as expired distribution of medicines. Aditya Wardhana, JOTHI coordinator for policy development and advocacy, said that giving patients just a few days’ supply of ARV was risky because the drug was handed out in unlabeled plastic bags that did not have expiration dates on them. “This is human lives we’re talking about,” he said. Just another way of showing in fact what numbers and statistics do not.

On 28–30 May 2009, the Thailand government held the XII National AIDS Seminar – Half of by 2011. Where are we? It was organized with the participation of Thai NGO Coalition on AIDS – TNCA, – that is composed of 17 networks and the Thai Network of People living with HIV/AIDS – TNP+. They created an official CS committee for organizing the National Seminar that had around twenty NGOs attending the meetings. Both TNCA and TNP+ used their communication channels to spread information among their members – around 850 groups of NGO and people living with HIV. Civil society also organized specific symposiums, skill-building workshops, community spaces and campaign activities during the seminar. It was informed by the media that around twenty-five hundred people attended the meeting, half of them organized civil society and PLHA groups and the other half government personnel.

Sign by the Youth Network of People Living with HIV

The importance of strengthening communication channels with CS is a key part of the government’s response in Thailand. Although the country is recognized because succeeded in addressing AIDS in many ways , this success does not guarantee that the HIV epidemic will come to a halt. In particular, the roots of the problem still exist and have often been overlooked by many policies in place.

Although, the communication channels between CS and government are not always reflected in the level of support accessed by civil society, particularly when related to funds allocation. The XII National Seminar was estimated by the media to cost 12 million Bahts. However it did face a lack of funds for CS participation that drove sex-worker groups to creates strategies on how to raise funds in order to participate in Seminar. Initially they decided to work harder (as sex workers) to support their own participation, but soon they realized that they would not be able to cover all their colleagues’ costs for traveling and lodging. They calculated how many clients they should attend, the number of days working, and how many of them would be necessary to engage to cover all people who wanted to attend the seminar. It would come short anyway. The mobilization was large and the idea led to an urgent meeting between NGOs and government to see how the matter could be solved. The result was that CS got support to include more one hundred people in the official budget. This is a very good example of how civil society mobilization works in Thailand.

UNGASS-AIDS: Monitoring Tool

Sexual and reproductive health in discussion at the XII National AIDS Seminar in Bankok, Thailand.

The National Seminar was also an important moment where the government expressed how helpful the UNGASS-AIDS Declaration of Commitment is to encourage both government and civil society to pay more attention to putting in place better M&E strategies for AIDS and health policies. Thailand is about to receive a new round of resources from the Global Fund – it will receive 100 million dollars for strengthening overall health system, and monitoring migrant, IDU, sex workers and MSM populations. The need to address these specific populations is evident. They estimate in three million the migrant population in the country, mainly coming from Laos, Cambodia and Myanmar. When they get infected with HIV or tuberculosis it is hard to access medicines, and without funds to pay for it, the situation has become a nightmare for them. The national health system is not prepared to absorb it and it is evident that there is no clear policy in place for addressing migrant women.

But even recognizing the need of the most affected populations, the problems in fact are much more complex and addressing all of them will require a more integrated, interdisciplinary, approach. Nowadays, for instance, one of the major challenge for the HIV/AIDS situation in Thailand is the increasing rate of HIV among youth – young sex workers, IDU, migrants, MSM, etc.

Government data showed that 1.127.168 cases of AIDS and symptomatic HIV infection were reported to the division of epidemiology. In total, 613.510 people died because of AIDS and, in 2008, eleven thousand new cases were registered. Only 19% of the general population has been tested. This percentage increases for sex workers (52.60%) and for MSM (34.90%,) however there is no data available for IDU. The government informed that 52.90% of the people who needs it are receiving ARV treatment, and PMTCT has been available 93.96% of the time.

It was also showed that AIDS is rapidly spreading among women. The 2008 UNGASS report showed that the ratio of HIV infection among women and men has significantly increased from 1:7 in the early days of the epidemic to 1:2.5 in 2005. From 2002, the morbidity of female youth (15–19 year-olds) has been higher than male youth at the same age (2:1). The youth groups at 15-24 years tend to have a high level of unsafe sex. According to the national behavioral surveillance survey (BSS) conducted by the Ministry of Public Health (MOPH), the percentage of youth that have ever had sex is increasing, and with low condom usage. This unsafe sex correlates with the increased incidence of HIV infection and unwanted pregnancy among youth.

UNGASS-AIDS Forum in the National AIDS Seminar

Discussions about the UNGASS-AIDS Declaration of Commitment were made in many sessions. Civil Society expressed that, according to the CS report for UNGASS 2008, the vast majority of HIV positive women face more difficulty in life, many carrying more burden after their husband dies. Moreover, stigmatization from their own communities prevents them from participating in everyday activities that are part of normal life. In addition, the inadequate information hinders accessibility to treatment, ARV, or appropriate counseling and other support activities in relation to the HIV/AIDS epidemic mitigation.

Thai UNGASS-AIDS Forum group in the XII National AIDS Seminar

One of the sessions in the National Seminar presented the study performed in 2008 by the UNGASS-AIDS Forum that collected data for monitoring the implementation of the national sexual and reproductive health policy in response to HIV/AIDS in Thailand. The area covered the implementation process of PMTCT strategies in nine provinces of five parts across the country. It was done from November 2007 to January 2008 with a total samples of 195 key informants, among them 108 HIV infected pregnant women.

The study, coordinated by the RaksThai Foundation analyzes information according to the process of PMTCT implementation in state hospitals, both at the community and provincial levels, in the nine provinces. [Access it on the link Reports]

And the good news is that government decided to implement a national research on PMTCT based on the research findings that highlights what the gaps still are on this program. An example of civil society proactively contributing to better implementation of public health services.

Synthesis of the UNGASS-AIDS Forum in Thailand:

• Held the 1st Forum in September 2007 with the participation of seventeen NGOs, networks, and Dr. Petchsri Sirinirun, Director of Epidemiology of the Ministry of Public Health.

• Concluded the research and, in January 2008, held the 2nd Forum to validate the collected data together with a national consultation with the Thai government. Over three hundred representatives of NGOs, networks, Government and UNAIDS took part in the event.

• The SRH and AIDS report produced by civil society focused on PMTCT was included as an annex in the National Report sent to UNAIDS in 2008, and Ms. Sunee Talawat, representative of the UNGASS-AIDS Forum Thailand was included in the national delegation for the HLM in the UN.

The arrival of wintertime in South Africa has not been able to cool down the III UNGASS-AIDS Forum discussions, held on June 8–9, in Cape Town. Twenty organizations – from HIV/AIDS, women, health and LGBT movements – participated in the event coordinated by MOSAIC, the meeting’s host, and Health Trust System, in partnership with Gestos, Brazil.

South Africa, with a population of 48 million, has a challenging HIV prevalence rate of 18.8%. Women have an infection rate of 55% of all cases. The AIDS epidemic has deeply marked South Africa in the past twenty years.

By specifically focusing in the sexual and reproductive health of women in the country, the Executive Coordinator of MOSAIC, Marieta de Vos, opened the UNGASS-AIDS Forum bringing up the importance of having civil society monitoring the goals accorded to by the government at the UNGASS-AIDS 2001. She also pointed out the goals of producing a research report, and an advocacy plan, in order to achieve better monitoring in the country. “We will put together a clear advocacy plan to keep the government accountable for sexual and reproductive health, what civil society can do, how we can work together with them, and how we can get issues in the map,” she said.

Marion Stevens, the coordinator of Health Trust Systems, highlighted that many advances in the AIDS field have been achieved since 2007, when the I UNGASS-AIDS Forum was held and few organizations acknowledged the declaration signed in 2001. She also highlighted that strategies have been discussed to strengthen the policies of SRH and HIV/AIDS locally. “We ought to: strengthen collaboration between SRH and HIV/AIDS advocacy organizations in the country; get SRH and rights into the agendas of AIDS policy discussions; develop advocacy actions toward the next high level meeting on UNGASS-AIDS in 2010; follow the ICPD+15 – International Commission on Population and Development – implementation; actively participate in the XVIII international AIDS Conference Vienna, in 2010; and build further international momentum for the inclusion of SRH and rights as a priority area”, said Stevens.

The presence of UNAIDS, represented by Henry Damisoni, M&E Officer, reinforced the importance of the UNGASS-AIDS Forum initiative. He defended the participation of civil society in the elaboration of country report, which will be presented in 2010, and also in the delegation that will go to the next UNGASS-AIDS High Level Meeting, in New York, as a way to strengthen the policies in the country. “We must have a single country response; and this response should not be divided by civil society and government. The goal is that UNGASS should serve the interests of the country as a whole, not only a process of exporting data to the UN. Initially UNGASS-AIDS was created to encourage governments to commit, but over time, the process has evolved from the government focus to a wider focus, showing how the country as a whole was responding to AIDS,” said Mr. Damisoni.

In the second part of the event, the country 2008 reports prepared by the government and by civil society were reviewed by the participants in order to put everyone on the same level of understanding and to analyze the strong and weak points the new monitoring effort should focus on. This was an important discussion for the second day of work that focused primarily on the analysis of the research tool that will be utilized to prepare the 2010 CS Report. The organizations divided the roles of the research, according to the subject of each theme. The aim is to prepare a high quality document to send to UNAIDS as a shadow report or as an annex of the country report, in the case the South African government accepts to include it.

Group work at the III UNGASS-AIDS Forum South Africa

Finally, after so much political and technical baggage, the groups defined some issues for the Advocacy Plan: cervical cancer, sterilization and medical abortion, were the main issues brought up. Part of the strategies includes data collection and “advocacy alerts” to be sent to government personnel, partners and media. A discreet set of communication tools will be used to try and reach as many people as possible, such as cell phone messaging, electronic discussion lists and press releases.

The IV UNGASS-AIDS Forum will be held in South Africa before the submission of civil society’s report to Gestos, in December. At this moment they will analyze what has been achieved thus far and strengthen their actions towards the UNGASS HLM in 2010.

Nearly half the people living with HIV in the world are women. Many factors cause this situation: poverty has a greater effect on women; inequity of power between men and women; and all forms of violence which are particularly driven towards women, including pure and simply historical misogyny.

There is a great difficulty in incorporating actions specifically for women in the diverse countries National Plans against HIV/AIDS. At the same time, the initiatives in the field of sexual and reproductive health for women have not been effective in preventing HIV infection; neither they have promoted sexual and reproductive rights of women living with HIV.

Therefore, it is necessary to give visibility for civil society monitoring proposals — that shows potential and shortcomings of public policies in each country— to effectively face the feminine side of the pandemic.

This project expects to deepen the debate about the UNGASS-AIDS—United Nations General Assembly Special Session on AIDS—2001 goals regarding sexual and reproductive health, and rights, in sixteen countries.

Advocacy Network

Civil Society and UNGASS-AIDS

Gestos, Brazilian NGO located in Recife, has utilized the Declaration of Commitment from UNGASS-AIDS 2001 as an instrument for advocacy and research of sexual and reproductive health of women and girls in public policies of sixteen countries. The project is funded by the Ford Foundation, with support from UNAIDS and the Center for International Technical Cooperation—CICT—of the Brazilian National AIDS Program.